MEDICARE: DR. HARRY DAVID CORSOVER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1299	CO

General Provider Information

NPI Number	:	1093983694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY DAVID CORSOVER PH.D.

Provider Business Mailing Address
First Line	:	3545 GOLDEN SPUR LOOP
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-8463
Country	:	US
Telephone Number	:	303-674-8448
Fax Number	:	303-674-9894

Provider Business Practice Location Address
First Line	:	3545 GOLDEN SPUR LOOP
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-8463
Country	:	US
Telephone Number	:	303-674-8448
Fax Number	:	303-674-9894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	07/22/2008

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